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We aimed to compare the risks of AKI and ESRD between aflibercept and ranibizumab in DMO patients, focusing on AKI and ESRD in conjunction with all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A target trial emulation using the TriNetX Global Collaborative Network included adult patients with DMO who initiated treatment with aflibercept or ranibizumab in routine clinical practice. Ranibizumab exposure reflected real-world use and included both approved dosages. Patients with pre-existing ESRD or chronic kidney disease stage 5 were excluded. Propensity score matching was applied to balance demographics, comorbidities, medication use, and laboratory parameters. Time-to-event analyses were performed for AKI, ESRD, and all-cause mortality. Sensitivity analyses included application of a minimum 7-day latency window after treatment initiation to address potential temporality bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After matching, 3411 patients were included in each treatment group (mean age, 64.0\u2009\u00b1\u200912.4 years; 51.5% male). During follow-up, aflibercept was not associated with an increased risk of AKI (hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.89-1.06), ESRD (HR: 0.95, 95% CI: 0.83\u20131.09), or all-cause mortality (HR: 0.99, 95% CI: 0.89\u20131.10), when compared with ranibizumab. Results were consistent across subgroup and sensitivity analyses, including analyses incorporating a 7-day latency window with an HR of 1.08 (95% CI: 0.94\u20131.24) for AKI, and 0.89 (95% CI: 0.76\u20131.04) for ESRD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this multinational, real-world study, aflibercept and ranibizumab demonstrated comparable risks of AKI, ESRD and mortality among patients with DMO after adjustment for measured confounders. Given the observational design, real-world dose heterogeneity, and limitations in detailed treatment-timing data, these findings should be interpreted with caution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41433-026-04459-4","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T06:05:16Z","timestamp":1776837916000},"page":"1446-1453","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of adverse renal events between ranibizumab and aflibercept in patients with diabetic macular oedema: A global network study"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9972-8899","authenticated-orcid":false,"given":"Wan-Ju Annabelle","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2841-0338","authenticated-orcid":false,"given":"Daniel Hsiang-Te","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Chun-Yuan","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3726-4803","authenticated-orcid":false,"given":"Yu-Shiuan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Yi","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Chieh","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5852-7652","authenticated-orcid":false,"given":"Edward Chia-Cheng","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"4459_CR1","doi-asserted-by":"publisher","first-page":"556","DOI":"10.2337\/dc11-1909","volume":"35","author":"JW Yau","year":"2012","unstructured":"Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. 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The data reviewed is a secondary analysis of existing data, does not involve intervention or interaction with human subjects, and is de-identified per the de-identification standard defined in Section \u00a7164.514(a) of the HIPAA Privacy Rule. The process by which the data is de-identified is attested to through a formal determination by a qualified expert as defined in Section \u00a7164.514(b)(1) of the HIPAA Privacy Rule. This formal determination by a qualified expert was refreshed in December 2020.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}